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iThe effective delivery of primary care requires the good working of a multi-professional team who provide that care. This accessible and concise text explores the ways in which primary care teams can collaborate well to advance the quality of clinical care and enhance collaborative working across the healthcare system as a whole. Taking a workbook approach, and including examples, narratives, case histories and further reading, Collaborative Practice in Primary and Community Care brings together theory and good practice to offer the reader viable models for achieving excellence. Addressing specific challenges to practising collaboratively throughout, it contains chapters exploring the contemporary context of primary care, collaboration with patients, collaboration between different professional groups, collaboration amongst organisations, and the respective roles of education and technology in promoting collaboration. Written by a multi-professional selection of experienced authors, practitioners and educators, this textbook is designed for a wide audience of healthcare professionals with an interest in primary care.

Background/Aims Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India. Methods 400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria. Results Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p  < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month. Conclusion Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.

Background Research-active healthcare institutions are associated with improved patient outcomes and staff satisfaction. However, research funding in the United Kingdom remains disproportionately concentrated in established academic centres, limiting opportunities for newer institutions – often located in regions with greater health need – to develop research capacity. This entrenches health inequalities and restricts the pipeline of clinical researchers in underserved areas. Methods We used a case study methodology to explore how one new United Kingdom medical school, situated within a teaching-focused university and region of relative socioeconomic disadvantage, built research capacity and supervisory infrastructure from the ground up. Drawing on internal expertise and infrastructure, strategic partnerships and national funding schemes, we examined the structural enablers and barriers encountered in establishing a locally relevant research ecosystem. Results A phased approach to capacity building was employed, starting with internal resources and strategic collaborations. Supervisory infrastructure was developed through networked partnerships, enabling undergraduate and postgraduate research opportunities. The creation of thematic research groups evolved into recognized research centres. This foundation enabled successful bids for competitive external funding, including undergraduate and postgraduate research schemes, which in turn developed research capacity. We highlight how equitable access to research opportunities – particularly for students from widening participation backgrounds – was embedded within the curriculum and supported by funded placements. Our experience demonstrates that early, targeted investment in research infrastructure, even in settings with low baseline research activity, can generate sustainable capacity, increase participation and reduce regional disparities in research engagement. Conclusions To promote equity in research funding and reduce health inequalities, national funding bodies should adopt more inclusive investment strategies that actively support emerging centres. Structural reform is needed to ensure that funding mechanisms do not solely reward existing capacity but also foster its development in underserved regions. Our findings offer a scalable model for building sustainable research ecosystems in new or underfunded centres, aligned with local health needs and population outcomes.

The development of high-quality clinicians takes place through immersion in clinical practice facilitated by educational supervisors with appropriate capabilities and organisational support to undertake the role. Learners give feedback on the quality of their learning experience on placement, which provides insights about the quality of clinical care received by patients.In this article, we explore the role of educational leaders in engaging with learner feedback about patient care, the challenges and tensions this generates, and the path through resolution. We use a lived example to showcase the issues raised and offer reflections on the challenges faced.

The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.

In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case study developed from our day-to-day experience working as clinical practitioners in primary care.

Background/Objectives Artificial intelligence (AI) assessment of diabetic retinopathy (DR) instead of scarce trained specialists could potentially increases the efficiency and accessibility of screening programs. This systematic review aims to systematically examine the uptake of follow-up appointments with initial computer-based AI and human graders of DR. Methods We conducted a systematic review and meta-analysis by screening articles in any languages in PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL and CDSR published from database inception up to 20 th August 2024. We used random-effects meta-analysis to pool the results as odds ratios (OR) with corresponding 95% confidence intervals (CI). Results Data from a total of 20,108 patients with diabetes (6476 participants graded using AI and 13,632 participants graded by human-graders; age range of the participants 5 to 67 years) from six studies were included. The result of the pooled meta-analysis showed that initial AI assessment of DR significantly increased uptake of follow-up appointments compared to human grader-based (OR = 1.89, 95% CI 1.78–2.01, P  = 0.00001). Conclusions The present systematic review and meta-analysis suggest that initial AI-based algorithm for screening DR is associated with an increased uptake of follow-up examination. This is most likely due to instant results being made available with AI based algorithms when compared to a delay in assessment with human graders.

Background In the UK, the Certificate of Vision Impairment (CVI) certifies a person as sight impaired (partially sighted) or severely sight impaired (blind). This is completed by ophthalmologists and passed with the patient’s consent to their GP, their local authority, and The Royal College of Ophthalmologists Certifications office. Once a person is certified, they can be registered by their local authority which is voluntary but enables the person to access rehabilitation or habitation services, financial concessions, welfare benefits and other services provided by local authorities. Methods We conducted semi-structured individual interviews with 17 patients with a diagnosed eye condition, 4 Eye Clinic Liaison Officers (ECLO) and 4 referring optometrists around their experiences around CVI and registration processes. Analysis of themes was conducted with results synthesised in a narrative analysis. Results Patients reported lack of clarity around the processes of certification and registration, benefits of certification and what happens beyond certification, the type of support that they are entitled to, delays in accessing support. Optometrists appear not to engage with the process much, especially if the patient is being treated by the hospital eye service. Conclusion Vision loss can be a devastating experience for the patient. There is a lack of information and confusion around the process. The lack of a joined-up process between certification and registration needs to be addressed if we are to provide the support that patients deserve in order to improve their quality of life and wellbeing.